Plasma surgery device

ABSTRACT

An electrosurgical wand is provided and includes a handle and an elongate shaft coupled to the handle and extending distally from the handle along an axis. An active electrode is disposed at a distal end of the electrosurgical wand. A return electrode abuts the elongate shaft and extends along and annularly about the axis. The return electrode has a top side adjacent the active electrode and an opposite bottom side and defines a notch. A support member is disposed in the notch between the electrodes and transitions curvilinearly from the notch to define a front surface extending laterally across and axially from the return electrode. The front surface tapers downwardly from the active electrode to define a first portion defining a first convex outer surface and also extends toward the bottom side of the return electrode to define a second portion defining a second convex outer surface.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is the U.S. national phase entry under 35 U.S.C. § 371of International Application No. PCT/US2018/026867, filed Apr. 10, 2018,entitled “Plasma Surgery Device,” which claims priority to and benefitof U.S. Provisional Application Ser. No. 62/483,802 filed Apr. 10, 2017,titled “Plasma Surgery Device,” the contents of which are incorporatedherein by reference in their entirety for all purposes.

BACKGROUND

Electrosurgical systems are used during surgical procedures to removeseveral different tissue types. For example, procedures involving theknee or shoulder may remove portions of cartilage, meniscus, and freefloating and/or trapped tissue. In some cases, the removal may be a veryslight removal, such as tissue sculpting, and in other cases moreaggressive removal of tissue is used. Electrosurgical systems may alsooperate in a coagulation mode, to seal arterial vessels exposed duringtissue removal, and sealing to reduce bleeding.

SUMMARY

There is provided an electrosurgical wand including a handle on aproximal end of the electrosurgical wand. An elongate shaft is coupledto the handle and extends distally from the handle along a longitudinalcentral axis. An active electrode is disposed at a distal end of theelectrosurgical wand and has an outer face and defining an exteriorperiphery extending thereabout. The active electrode resides within anddefines a plane spaced from and extending along and laterally from thelongitudinal central axis. A return electrode abuts the elongate shaftand extends along and annularly about the longitudinal central axis. Thereturn electrode has a top side adjacent the active electrode and abottom side disposed remotely from the active electrode and opposite thetop side. At least a portion of the return electrode is disposedproximally to the active electrode. The top side of the return electrodehas a first length measured axially from the elongate shaft and thebottom side has a second length measured axially from the elongate shaftbeing greater than the first length to define a notch enabling thebottom side of the return electrode and the active electrode to overlapalong the longitudinal central axis in an overlap region. A supportmember that is electrically insulative is disposed in the notch betweenthe active electrode and the return electrode and extending axially fromthe return electrode. The support member is coupled to and supports theactive electrode. The support member transitions curvilinearly from thenotch of the return electrode axially and tapers to a distal tipadjacent the active electrode to define a front surface extendinglaterally across and axially from the return electrode. The frontsurface tapers downwardly from the active electrode to define a firstportion disposed adjacent the active electrode and defining a firstconvex outer surface. The front surface also extends toward the bottomside of the return electrode to define a second portion disposedadjacent the bottom side of the return electrode and defining a secondconvex outer surface. The support member holds the active electrode afirst distance from the longitudinal central axis that is greater than asecond distance from the longitudinal central axis to the top side ofthe return electrode.

In some embodiments, the support member has a mid-section disposedbetween the first portion and the second portion of the front surfaceand defining a concave outer surface axially undercutting the activeelectrode toward the proximal end of the electrosurgical wand.

In some embodiments, the concave section has a member radius ofcurvature having a center disposed on a side of the longitudinal centralaxis being the same as the active electrode.

In some embodiments, the notch defines a circuitous edge extendingarcuately across the top side of the return electrode between a pair ofcorners to define an upper segment and from the pair of corners axiallytoward the distal end to define a pair of horizontal segments laterallyopposite one another and each extending axially to end at respectiveshoulders and from the shoulders extending arcuately around the bottomside of the return electrode to define a lower segment and wherein thesupport member includes a rear edge extending along and correspondingwith the circuitous edge of the return electrode.

In some embodiments, the lower segment of the circuitous edge is angledaxially away from the distal end as the circuitous edge extends awayfrom the longitudinal central axis at a lower edge segment anglerelative to the longitudinal central axis.

In some embodiments, at least one of the shoulders and the corners isrounded.

In some embodiments, the electrosurgical wand further includes anaspiration channel defined within the elongate shaft and the activeelectrode further comprises at least one aperture that defines a suctionlumen, the at least one aperture is disposed over an opening into theaspiration channel.

In some embodiments, the support member includes at least one shelfextending axially along and disposed below the exterior periphery of theactive electrode and extending laterally outwardly from the supportmember.

In some embodiments, the at least one shelf is angled at a shelf anglerelative to the outer face of the active electrode.

In some embodiments, the shelf angle is between 30 and 60 degrees.

There is also provided an electrosurgical wand comprising including ahandle on a proximal end of the electrosurgical wand. An elongate shaftis coupled to the handle and extends distally from the handle along alongitudinal central axis. An active electrode is disposed at a distalend of the electrosurgical wand and has an outer face and resides withinand defining a plane spaced from and extending along and laterally fromthe longitudinal central axis. A return electrode abuts the elongateshaft and extends along and annularly about the longitudinal centralaxis. The return electrode has a top side adjacent the active electrodeand a bottom side disposed remotely from the active electrode andopposite the top side. At least a portion of the return electrode isdisposed proximally to the active electrode. A support member that iselectrically insulative is disposed between the active electrode and thereturn electrode and extends axially from the return electrode and iscoupled to and supports the active electrode. The active electrode hasan oblong shape viewed perpendicular to the plane within which theactive electrode resides with a wider portion and a narrower portionnarrowing with increasing distal distance from the wider portion. Theactive electrode is disposed distally with respect to the wider portionand defines an exterior periphery extending thereabout including a pairof side edges. The active electrode includes a plurality of protrusionsextending away from the outer face of the active electrode in adirection away from the longitudinal central axis.

In some embodiments, the plurality of protrusions includes a pair ofrear protrusions spaced from and on opposite sides of the longitudinalcentral axis in the wider portion and a pair of front protrusions spacedfrom and on opposite sides of the longitudinal central axis and axiallyspaced from the rear protrusions in the narrower portion.

In some embodiments, the pair of front protrusions each angles laterallyinwardly toward the longitudinal central axis as they extend axiallyaway from the wider portion.

In some embodiments, the pair of side edges each is slightly convex andconverges with one another at an active electrode apex in the narrowingportion and connected at a truncated end being linear and extendinglaterally from the longitudinal central axis in the wider portion.

In some embodiments, the pair of side edges each has an edge radius ofcurvature having a center on an opposite side of the longitudinalcentral axis from the respective one of the pair of side edges.

In some embodiments, the longitudinal central axis does not intersectthe plane within the periphery of the active electrode.

In some embodiments, the longitudinal central axis is parallel to theplane.

In some embodiments, the electrosurgical wand further includes anaspiration channel defined within the elongate shaft and the activeelectrode further comprises at least one aperture that defines a suctionlumen, the at least one aperture is disposed over an opening into theaspiration channel.

Further features and advantages of at least some of the embodiments ofthe present invention, as well as the structure and operation of variousembodiments of the present invention, are described in detail below withreference to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

For a detailed description of example embodiments, reference will now bemade to the accompanying drawings in which:

FIG. 1 shows an electrosurgical system in accordance with at least someembodiments;

FIG. 2 shows an elevation view of an electrosurgical wand in accordancewith at least some embodiments;

FIG. 3 shows a perspective view of a distal end of an electrosurgicalwand in accordance with at least some embodiments;

FIG. 4A shows an overhead view of an electrosurgical wand in accordancewith at least some embodiments;

FIG. 4B shows of a side elevation view of the electrosurgical wand inaccordance with at least some embodiments;

FIG. 4C shows another perspective view of the distal end of theelectrosurgical wand in accordance with at least some embodiments;

FIG. 4D shows an end view of the distal end of the electrosurgical wandin accordance with at least some embodiments; and

FIG. 5 shows an electrical block diagram of a controller in accordancewith at least some embodiments.

DEFINITIONS

Various terms are used to refer to particular system components.Different companies may refer to a component by different names—thisdocument does not intend to distinguish between components that differin name but not function. In the following discussion and in the claims,the terms “including” and “comprising” are used in an open-endedfashion, and thus should be interpreted to mean “including, but notlimited to . . . .” Also, the term “couple” or “couples” is intended tomean either an indirect or direct connection. Thus, if a first devicecouples to a second device, that connection may be through a directconnection or through an indirect connection via other devices andconnections.

Reference to a singular item includes the possibility that there areplural of the same items present. More specifically, as used herein andin the appended claims, the singular forms “a,” “an,” “said” and “the”include plural references unless the context clearly dictates otherwise.It is further noted that the claims may be drafted to exclude anyoptional element. As such, this statement serves as antecedent basis foruse of such exclusive terminology as “solely,” “only” and the like inconnection with the recitation of claim elements, or use of a “negative”limitation. Lastly, it is to be appreciated that unless definedotherwise, all technical and scientific terms used herein have the samemeaning as commonly understood by one of ordinary skill in the art towhich this invention belongs.

“Ablation” shall mean removal of tissue based on tissue interaction withplasma.

“Plasma” shall mean a low temperature gas formed of vapor bubbles or avapor layer that is capable of emitting an ionized discharge.

“Active electrode” shall mean an electrode of an electrosurgical wandwhich produces an electrically-induced tissue-altering effect whenbrought into contact with, or close proximity to, a tissue targeted fortreatment.

“Return electrode” shall mean an electrode of an electrosurgical wandwhich serves to provide a current flow path for electrical charges withrespect to an active electrode, and/or an electrode of an electricalsurgical wand which does not itself produce an electrically-inducedtissue-altering effect on tissue targeted for treatment.

“Top side” shall mean a first side of a return electrode of anelectrosurgical wand that is on the same side of a longitudinal centralaxis, along which the electrosurgical wand extends, as the activeelectrode.

“Bottom side” shall mean a second side of a return electrode of anelectrosurgical wand that is on the opposite side of a longitudinalcentral axis, along which the electrosurgical wand extends, as theactive electrode.

Where a range of values is provided, it is understood that everyintervening value, between the upper and lower limit of that range andany other stated or intervening value in that stated range isencompassed within the invention. Also, it is contemplated that anyoptional feature of the inventive variations described may be set forthand claimed independently, or in combination with any one or more of thefeatures described herein.

All existing subject matter mentioned herein (e.g., publications,patents, patent applications and hardware) is incorporated by referenceherein in its entirety except insofar as the subject matter may conflictwith that of the present invention (in which case what is present hereinshall prevail). The referenced items are provided solely for theirdisclosure prior to the filing date of the present application. Nothingherein is to be construed as an admission that the present invention isnot entitled to antedate such material by virtue of prior invention.

DETAILED DESCRIPTION

Before the various embodiments are described in detail, it is to beunderstood that the disclosure is not limited to particular variationsset forth herein as various changes or modifications may be made, andequivalents may be substituted, without departing from the spirit andscope of the invention. As will be apparent to those of skill in the artupon reading this disclosure, each of the individual embodimentsdescribed and illustrated herein has discrete components and featureswhich may be readily separated from or combined with the features of anyof the other several embodiments without departing from the scope orspirit of the present invention. In addition, many modifications may bemade to adapt a particular situation, material, composition of matter,process, process act(s) or step(s) to the objective(s), spirit or scopeof the present invention. All such modifications are intended to bewithin the scope of the claims made herein.

FIG. 1 shows an electrosurgical system 100 in accordance with at leastsome embodiments. In particular, the electrosurgical system 100comprises an electrosurgical wand 102 (hereinafter “wand 102”) coupledto an electrosurgical controller 104 (hereinafter “controller 104”). Thewand 102 comprises an elongate shaft 106 that defines distal end 108.The elongate shaft 106 further defines a handle 110 at a proximal end111, where a physician grips the wand 102 during surgical procedures.The wand 102 further comprises a flexible multi-conductor cable 112housing one or more electrical leads (not specifically shown in FIG. 1), and the flexible multi-conductor cable 112 terminates in a wandconnector 114. As shown in FIG. 1 , the wand 102 couples to thecontroller 104, such as by a controller connector 120 on an outersurface of the enclosure 122 (in the illustrative case of FIG. 1 , thefront surface).

Though not visible in the view of FIG. 1 , in some embodiments the wand102 has one or more internal fluid conduits coupled to externallyaccessible tubular members. As illustrated, the wand 102 has a flexibletubular member 116, used to provide aspiration at the distal end 108 ofthe wand. In accordance with various embodiments, the tubular member 116couples to a peristaltic pump 118, which peristaltic pump 118 isillustratively shown as an integral component with the controller 104(i.e., residing at least partially within the enclosure 122 of thecontroller 104). In other embodiments, an enclosure for the peristalticpump 118 may be separate from the enclosure 122 for the controller 104(as shown by dashed lines in FIG. 1 ), but in any event the peristalticpump is operatively coupled to the controller 104. In yet still furtherembodiments, suction for aspiration may be provided from any suitablesource, such as suction outlets available in hospital settings. Theexample peristaltic pump 118 comprises a rotor portion 124 (hereafterjust “rotor 124”) as well as a stator portion 126 (hereafter just“stator 126”). The example flexible tubular member 116 couples withinthe peristaltic pump 118 between the rotor 124 and the stator 126, andmovement of the rotor 124 against the flexible tubular member 116 causesfluid movement toward the discharge 128.

Still referring to FIG. 1 , a display device or interface device 130 isvisible through the enclosure 122 of the controller 104, and in someembodiments a user may select operational characteristics of thecontroller 104 by way of the interface device 130 and related buttons132. For example, using one or more of the buttons 132 the surgeon mayselect among energy ranges for use with the wand 102 duringelectrosurgical procedures.

In some embodiments the electrosurgical system 100 also comprises a footpedal assembly 134. The foot pedal assembly 134 may comprise one or morepedal devices 136 and 138, a flexible multi-conductor cable 140 and apedal connector 142. While only two pedal devices 136 and 138 are shown,one or more pedal devices may be implemented. The enclosure 122 of thecontroller 104 may comprise a corresponding connector 144 that couplesto the pedal connector 142. A physician may use the foot pedal assembly134 to control various aspects of the controller 104, such as the modeof ablation. For example, pedal device 136 may be used for on-offcontrol of the application of radio frequency (RF) energy to the wand102. Further, pedal device 138 may be used to control and/or set themode of operation of the electrosurgical system. For example, actuationof pedal device 138 may switch between ablation mode and coagulationmode.

The electrosurgical system 100 of the various embodiments implementsablation which employs Coblation® technology. In particular, theassignee of the present disclosure is the owner of Coblation®technology. Coblation® technology involves the application of a radiofrequency (RF) signal between one or more active electrodes and one ormore return electrodes of the wand 102 to develop high electric fieldintensities in the vicinity of the target tissue. The electric fieldintensities may be sufficient to vaporize an electrically conductivefluid over at least a portion of the one or more active electrodes inthe region between the one or more active electrodes and the targettissue. The electrically conductive fluid may be inherently present inthe body, such as blood, or in some cases extracellular or intracellularfluid. In other embodiments, the electrically conductive fluid may be aliquid or gas, such as isotonic saline. In some embodiments, such assurgical procedures involving a knee or shoulder, the electricallyconductive fluid is delivered in the vicinity of the active electrodeand/or to the target site by a delivery system separate and apart fromthe system 100.

When the electrically conductive fluid is heated to the point that theatoms of the fluid vaporize faster than the atoms recondense, a gas isformed. When sufficient energy is applied to the gas, the atoms collidewith each other causing a release of electrons in the process, and anionized gas or plasma is formed (the so-called “fourth state ofmatter”). Stated otherwise, plasmas may be formed by heating a gas andionizing the gas by driving an electric current through the gas, or bydirecting electromagnetic waves into the gas. The methods of plasmaformation give energy to free electrons in the plasma directly,electron-atom collisions liberate more electrons, and the processcascades until the desired degree of ionization is achieved. A morecomplete description of plasma can be found in Plasma Physics, by R. J.Goldston and P. H. Rutherford of the Plasma Physics Laboratory ofPrinceton University (1995), the complete disclosure of which isincorporated herein by reference.

As the density of the plasma becomes sufficiently low (i.e., less thanapproximately 1020 atoms/cm³ for aqueous solutions), the electron meanfree path increases such that subsequently injected electrons causeimpact ionization within the plasma. When the ionic particles in theplasma layer have sufficient energy (e.g., 3.5 electron-Volt (eV) to 5eV), collisions of the ionic particles with molecules that make up thetarget tissue break molecular bonds of the target tissue, dissociatingmolecules into free radicals which then combine into gaseous or liquidspecies. By means of the molecular dissociation (as opposed to thermalevaporation or carbonization), the target tissue is volumetricallyremoved through molecular dissociation of larger organic molecules intosmaller molecules and/or atoms, such as hydrogen, oxygen, oxides ofcarbon, hydrocarbons and nitrogen compounds. The molecular dissociationcompletely removes the tissue structure, as opposed to dehydrating thetissue material by the removal of liquid within the cells of the tissueand extracellular fluids, as occurs in related art electrosurgicaldesiccation and vaporization. A more detailed description of themolecular dissociation can be found in commonly assigned U.S. Pat. No.5,697,882 the complete disclosure of which is incorporated herein byreference.

The energy density produced by electrosurgical system 100 at the distalend 108 of the wand 102 may be varied by adjusting a variety of factors,such as: the number of active electrodes; electrode size and spacing;electrode surface area; asperities and/or sharp edges on the electrodesurfaces; electrode materials; applied voltage; current limiting of oneor more electrodes (e.g., by placing an inductor in series with anelectrode); electrical conductivity of the fluid in contact with theelectrodes; density of the conductive fluid; and other factors.Accordingly, these factors can be manipulated to control the energylevel of the excited electrons. Since different tissue structures havedifferent molecular bonds, the electrosurgical system 100 may beconfigured to produce energy sufficient to break the molecular bonds ofcertain tissue but insufficient to break the molecular bonds of othertissue. For example, fatty tissue (e.g., adipose) has double bonds thatrequire an energy level higher than 4 eV to 5 eV (i.e., on the order ofabout 8 eV) to break. Accordingly, the Coblation® technology in somemodes of operation does not ablate such fatty tissue; however, theCoblation® technology at the lower energy levels may be used toeffectively ablate cells to release the inner fat content in a liquidform. Other modes of operation may have increased energy such that thedouble bonds can also be broken in a similar fashion as the single bonds(e.g., increasing voltage or changing the electrode configuration toincrease the current density at the electrodes). A more completedescription of the various phenomena can be found in commonly assignedU.S. Pat. Nos. 6,355,032, 6,149,120 and 6,296,136, the completedisclosures of which are incorporated herein by reference.

FIG. 2 shows a side elevation view of wand 102 in accordance withexample systems. The wand 102 comprises elongate shaft 106 which may beflexible or rigid, and a handle 110 coupled to the proximal end 111 ofthe elongate shaft 106. At the distal end 108 resides an activeelectrode 200, a return electrode 202, and an electrode support member204. The relationship of the various elements at the distal end 108 ofthe wand 102 will be discussed in greater below. Active electrode 200may be coupled to an active or passive control network within controller104 (FIG. 1 ) by means of one or more insulated electrical connectors(not shown) in the multi-conductor cable 112. The active electrode 200is electrically isolated from a common or return electrode 202 which isdisposed on the elongate shaft 106. Proximally from the distal tip, thereturn electrode 202 is concentric with the elongate shaft 106 of thewand 102. The support member 204 is positioned distal to the returnelectrode 202 and may be composed of an electrically insulating materialsuch as epoxy, plastic, ceramic, silicone, glass or the like. Supportmember 204 extends from the distal end 108 of elongate shaft 106(usually about 1 to 20 mm) and provides support for active electrode200. Before describing the example wand in greater detail, thespecification turns a brief discussion of the related-art devices.

Related-art electrosurgical devices, including plasma mediated systems,are used during shoulder arthroscopic surgery mostly to remove softtissue in the sub-acromial space during a procedure called “sub-acromialdecompression” (SAD). Most devices on the market use a geometry with theactive electrode generally residing in a plane parallel to and displacedaway from the shaft axis (sometimes referred to as 90 degreesperpendicular to the shaft axis, compared to an electrode that residesin a plane perpendicular to the shaft axis). The related-art electrodesand device tips are usually rounded and relatively flat to beatraumatic. However, devices with rounded tips do not provide very goodaccess to any other tissues besides the bursa that needs to be removedduring these procedures.

For other shoulder arthroscopy procedures, instruments with tip designsdiffering from those described in the immediately preceding paragraphare often used to allow better access to the target tissue. These othershoulder arthroscopy procedures may include tissue dissection of muscleplanes, separation of the labrum for glenoid surface, sculpting of thelabrum chondroplasty of the humeral head of glenoid surface ordissection to perform a Latarjet shoulder stabilization procedure. Usinga different instrument for these procedures may add to the cost of theoverall procedure. Moreover, when using a different instrument somepathology may not be treated, such as labrum or cartilage defects, wherethey could be treated with an appropriate Coblation® device.

FIG. 3 shows a perspective view of the distal end 108 of the wand 102 inaccordance with example embodiments. In particular, visible in FIG. 3 isthe elongate shaft 106 that extends along and defines a longitudinalcentral axis 300. Disposed at the distal end 108 is the return electrode202. In the example system, the return electrode 202 also has a centralaxis that is coaxial with the longitudinal central axis 300. In moredetail, the return electrode 202 abuts the elongate shaft 106 andextends along and annularly about the longitudinal central axis 300.

An electrode support device or support member 204 is coupled to thereturn electrode 202 at least partially distally thereof, and as thename implies the support member 204 supports the active electrode 200.In the example system, the active electrode 200 defines and resideswithin a plane, and in the embodiment shown the plane defined by theactive electrode 200 is parallel to, spaced from, and extending alongthe longitudinal central axis 300. Stated otherwise, the example activeelectrode 200 faces outwardly at 90 degrees from the longitudinalcentral axis 300. The plane and active electrode 200 additionallyextends laterally from the longitudinal central axis 300. In the exampledevice shown, the longitudinal central axis 300 does not intersect theplane defined by the active electrode 200. However, in other examplecases the support member 204 may orient the active electrode 200 atvarious angles. For example, if the active electrode 200 is slopedtoward the distal end 108 of the wand 102, the longitudinal central axis300 may intersect the plane distally of the wand 102. As anotherexample, if the active electrode 200 is sloped toward the proximal end111 (FIG. 2 ) of the wand 102, the longitudinal central axis 300 mayintersect the plane proximally of the distal end 108 of the wand 102.Regardless, in example embodiments the longitudinal central axis 300does not intersect the plane of the active electrode 200 within theexterior periphery 400 (FIG. 4A) of the active electrode 200.

Still referring to FIG. 3 , in the example wand 102 shown, the returnelectrode 202 has a top side 308 adjacent the active electrode 200 and abottom side 310 disposed remotely from the active electrode 200 andopposite the top side 308. The top side 308 of the return electrode 202has a first length L₁ measured axially from the elongate shaft 106 andthe bottom side 310 has a second length L₂ measured axially from theelongate shaft 106 being greater than the first length L₁ to define anotch or cutout 302, and the support member 204 telescopes within thereturn electrode 202 and resides within the notch 302. Thus, the returnelectrode 202 is not only defined proximally from the active electrode200, but a portion of the return electrode 200 and the active electrode200 overlap when measured or considered along the longitudinal centralaxis 300. More specifically, the notch 302 enables the bottom side 310of the return electrode 202 and the active electrode 200 to overlapalong the longitudinal central axis 300 in an overlap region 312. Thus,at least a portion of the return electrode 202 is disposed proximally tothe active electrode 200.

Active electrode 200 in the example system defines an opening oraperture 304 therethrough. The aperture 304 is disposed above an openingin the support member 204 that is in fluid communication with theaspiration channel through the elongate shaft 106. Thus, the aperture304 defines a suction lumen through the active electrode 200.

Finally with respect to FIG. 3 , the example active electrode 200further defines a plurality of protrusions 306, 307 and as shown, foursuch protrusions 306, 307. The plurality of protrusions 306, 307 extendaway from the outer face 314 of the active electrode 200. Statedotherwise, the plurality of protrusions 306, 307 extend away from theouter face 314 of the active electrode 200 in a direction away from thelongitudinal central axis 300.

FIG. 4A shows an overhead view of the distal end 108 of the wand 102 ofFIG. 3 . In particular, visible in FIG. 4A is the active electrode 200,the support member 204, and the return electrode 202. The activeelectrode 200 in the example systems has the ovate or oblong shape whenviewed perpendicular to the plane within which the active electrode 200defines and resides (i.e., when viewed as in FIG. 4A). More particular,the example active electrode 200 defines an exterior periphery 400, awider portion 402 and a narrower portion 404. The wider portion 402 isdisposed proximal of the narrower portion 404, and the narrower portion404 is disposed distally and narrows with increasing distal distancefrom the wider portion 402. The side edges 406 and 408 of the narrowerportion 404 are shown to have a slightly convex shape, which may behelpful when the electrosurgical wand 102 is turned and the ablationperformed along the side edges 406, 408. Furthermore, the side edges 406and 408 converge with one another at an active electrode apex 410 in thenarrower portion 404 and are connected at a truncated end 412 that islinear and extends laterally from the longitudinal central axis 300 inthe wider portion 402. In more detail, the pair of side edges 406, 408each has an edge radius of curvature R_(e) having a center 414 on anopposite side of the longitudinal central axis 300 from the respectiveone of the pair of side edges 406, 408. In other cases, the side edges406 and 408 may be straight and converge at the active electrode apex410.

Also visible in FIG. 4A is the aperture 304. Thus, active electrode 200and the aperture 304 form a screen electrode, and various ablationbyproducts may be aspirated through the aperture 304. It should beunderstood that while one aperture 304 is shown, any number of apertures304 may be used.

In addition, as best shown in FIG. 4A, the plurality of protrusions 306,307 includes a pair of rear protrusions 306 spaced from and on oppositesides of the longitudinal central axis 300 in the wider portion 402 anda pair of front protrusions 307 spaced from and on opposite sides of thelongitudinal central axis 300 and axially spaced from the rearprotrusions 306 in the narrower portion 404. Also, the pair of frontprotrusions 307 each angles laterally inwardly toward the longitudinalcentral axis 300 as they extend axially away from the wider portion 402.

FIG. 4B shows a side-elevation view of the distal tip of the wand ofFIGS. 3 and 4A. In particular, visible in FIG. 4B is the activeelectrode 200, the support member 204, the return electrode 202, and theelongate shaft 106. FIG. 4B illustrates several features, such as thenotch 302 occupied by the support member 204, and which notch 302enables overlap in the axial direction of the active electrode 200 andthe return electrode 202. Moreover, two of the example protrusions 306,307 (i.e., one each of the pair of rear protrusions 306 and the pair offront protrusions 307) are visible in the view of FIG. 4B, and again theplurality of protrusions 306, 307 extend from the outer face 314 of theactive electrode 200.

The notch 302 defines a circuitous edge 418 extending arcuately acrossthe top side 308 of the return electrode 202 between a pair of corners420 to define an upper segment 422. The circuitous edge 418 also extendsfrom the pair of corners 420 axially toward the distal end 108 to definea pair of horizontal segments 424 laterally opposite one another andeach extending axially to end at respective shoulders 426. Additionally,the circuitous edge 418 extends from the shoulders 426 and extendsarcuately around the bottom side 310 of the return electrode 202 todefine a lower segment 428. As a result, the support member 204 includesa rear edge 430 extending along and corresponding with the circuitousedge 418 of the return electrode 202. Also, the lower segment 428 of thecircuitous edge 418 is angled axially away from the distal end 108 asthe circuitous edge 418 extends away from the longitudinal central axis300 at a lower edge segment angle a relative to the longitudinal centralaxis 300. At least one of the shoulders 426 and the 420 corners isrounded or curved.

Moreover, FIG. 4B illustrates that the support member 204 transitionscurvilinearly from the notch 302 of the return electrode 202 axially andtapers to a distal tip 432 adjacent the active electrode 200 to define afront surface 434 extending laterally across and axially from the returnelectrode 202 and tapering downwardly from the active electrode 200 todefine a first portion 436 disposed adjacent the active electrode 200and defining a first convex outer surface 438. The front surface 434also extends toward the bottom side 310 of the return electrode 202 todefine a second portion 440 disposed adjacent the bottom side 310 of thereturn electrode 202 and defining a second convex outer surface 442.Thus, the support member 204 holds the active electrode 200 a firstdistance D₁ from the longitudinal central axis 300 being greater than asecond distance D₂ from the longitudinal central axis 300 to the topside 308 of the return electrode 202.

In some embodiments, the support member 204 has a mid-section 444disposed between the first portion 436 and the second portion 440 of thefront surface 434 that defines a concave outer surface 446 axiallyundercutting the active electrode 200 toward the proximal end 111 (FIG.2 ). Specifically, the concave outer surface 446 has a member radius ofcurvature Rm having a center 448 on the same side of the longitudinalcentral axis 300 as the active electrode 200. However, it should beappreciated that various member radii of curvature R_(m) and/or centers448 may be utilized. The mid-section 444 creates “hook” that the surgeonmay use to manipulate the placement of tissue during the surgicalprocedures. Nevertheless, the example support member 204 makes arelatively smooth transition to the distal tip 432 and makes arelatively smooth transition to the return electrode 202 to reduce thechances of inadvertently snagging or grabbing tissue.

Summarizing before continuing, the example active electrode 200 has anoblong shape, with the larger dimension or diameter more or lessparallel to the longitudinal central axis of the elongate shaft 106(FIG. 3 ). The oblong shape provides more or less flat side edges 406,408 (slightly convex) for treating cartilage, a fine tip (i.e., activeelectrode apex 410 and distal tip 432) for soft tissue dissection, and arelatively low profile in both planes to be used as an instrument tomanipulate different tissues as well. Although shown as a 90 degree tip,as discussed other angles of the active electrode 200 to thelongitudinal central axis 300 are possible.

The support member 204 (e.g., ceramic) on which the active electroderests also tapers toward the distal tip 432 in order to form a thinnerassembly (e.g., FIG. 4A). FIG. 4B also shows that the ceramic, as ittapers has a mid-section 444 defining a concave outer surface 446enabling a manipulation of tissue like a “hook.”

Viewed from the “top” (FIG. 4A), the side edges 406 and 408 of theactive electrode 200 are relatively close to the edge of the ceramicinsulation that forms the support member 204, and the side edges 406 and408 also have an almost straight or slight convex shape. The shapeenables cartilage treatment when using the device on its side.

In some embodiments, the support member 204 can also have at least oneshelf 450 extending axially along and spaced from the exterior periphery400 of the active electrode 200. The shelf 450 is oriented or angled ata shelf angle β relative to the outer face 314 of the active electrode200 and can be used as a visual marker for the location of the distaltip 432. According to an aspect, the shelf angle β can be between 30 and60 degrees.

The example active electrode 200 is made of metal, in this case a metalinjection mould made of an alloy mostly composed of tungsten. The activeelectrode 200 can have one or more apertures to form a suction lumenthat removes both tissue debris and bubbles.

As discussed, the active electrode 200 may have features on the outerface 314 of the active electrode 200 such as the plurality ofprotrusions 306 (e.g., that may protrude 0.1-2.0 mm, an in other cases0.3-1.02 mm) in order to provide better tactile feedback to the surgeonwhen treating tissue place on hard surface like bone. The features onthe distal part of the active electrode 200 will also be designed suchthat when the active electrode apex 410 of the active electrode 200 isused at an angle and on its edge (e.g., to treat articular cartilage),the features remain at a distance from the cartilage surface so they donot affect the effect of the exterior periphery 400 (e.g., side edges406, 408) of the active electrode 200 on tissue. In example cases theactive electrode 200, and specifically the side edges 406 and 408,reside about 0.127 mm from the edge of the support member 204, whileremaining portions of the active electrode 200 are set back a greaterdistance (e.g., about 0.356 mm at the proximal end of the activeelectrode 200). In example cases, the support member 204 is, at itswidest, about 3.76 mm (measured perpendicular to the longitudinalcentral axis 300 and parallel to the plane of the active electrode 200).In example cases the width of the support member 204 just below theactive electrode 200 (and again measured perpendicular to thelongitudinal central axis 300 and parallel to the plane of the activeelectrode 200) may be about 3.30 mm, while the width of the activeelectrode 200 at the along the same measurement direction is about 3.05mm. Finally, in example cases the thickness of the overall distal tip(measured from outer face 314 of the active electrode 200 to the bottomside 310 of the return electrode 202) is about 3.91 mm to about 4.34 mm.Other sizes are possible.

The versatility of the example wand design is further improved when usedon an ablation platform which optimizes tissue effects for various typeof tissue or anatomy. Further, the active electrode 200 could be splitin two or more electrodes: a first electrode with the proximal part forgross tissue debulking, and the tip electrode (the distal “triangle”)that used for fine dissection mode. Each electrode (i.e., separate partsof the active electrode 200) can be connected to a different output ofthe generator. Both electrodes or only the proximal electrode can beactivated for gross debulking, while only the tip can be activated formore precision and lower power dissipation when needed for finedissection or debridement of cartilage or meniscus.

The example devise may have a slightly smaller profile than related art90° devices, with the same effect on soft tissue as related art 90°devices when used in shoulder sub-acromial decompression or kneenotchplasty. However, the features described herein enable the device tobe used for other procedures within shoulder and knee arthroscopy. Theability to perform the additional procedures provides a much moreversatile device that saves time and or money for surgeons as more canbe accomplished with a single device, thereby reducing the need to useor switch to a different type of instrument.

FIGS. 4C and 4D show additional views of the distal end 108 of wand 102in accordance with example embodiments.

FIG. 5 shows an electrical block diagram of controller 104 in accordancewith at least some embodiments. In particular, the controller 104comprises a processor 500. The processor 500 may be a microcontroller,and therefore the microcontroller may be integral with read-only memory(ROM) 502, random access memory (RAM) 504, flash or other non-volatileprogrammable memory, digital-to-analog converter (D/A) 506,analog-to-digital converter (A/D) 514, digital outputs (D/O) 508, anddigital inputs (D/I) 510. The processor 500 may further provide one ormore externally available peripheral busses (e.g., I²C, USB). Theprocessor 500 may further be integral with communication logic 512(e.g., UARTs, Ethernet enabled ports) to enable the processor 500 tocommunicate with external devices, as well as internal devices, such asdisplay device 130. Although in some embodiments the processor 500 maybe implemented in the form of a microcontroller, in other embodimentsthe processor 500 may be implemented as a standalone central processingunit in combination with individual RAM, ROM, communication, ND, D/A,DO, DI devices, and communication hardware for communication toperipheral components. In some example systems, the processor 500 andrelated functionality are implemented as a MK60 series microcontrolleravailable from Freescale Semiconductor of Austin, Tex.; however, othermicrocontrollers may be equivalently used.

ROM 502 (or possibly a flash memory) stores instructions executable bythe processor 500. In particular, the ROM 502 may comprise a softwareprogram that, when executed, causes the processor to sum, over varioustime windows, energy delivery and when needed temporarily cease or“pulse” the energy provided to ensure the rate of energy delivery doesnot exceed predetermined thresholds (discussed more below). The RAM 504may be the working memory for the processor 500, where data may betemporarily stored and from which instructions may be executed.Processor 500 couples to other devices within the controller 104 by wayof the digital-to-analog converter 506 (e.g., in some embodiment the RFvoltage generator 516), digital outputs 508 (e.g., in some embodimentthe RF voltage generator 516), digital inputs 510 (e.g., interfacedevices such as push button switches 132 or foot pedal assembly 134(FIG. 1 )), and communication device 512 (e.g., display device 130).

Voltage generator 516 generates an alternating current (AC) voltagesignal that is coupled to active electrode(s) (e.g., active electrode200) of the example wand. In some embodiments, the voltage generatordefines an active terminal 518 which couples to electrical pin 520 inthe controller connector 120, electrical pin 522 in the wand connector114, and ultimately to the active electrode(s). Likewise, the voltagegenerator defines a return terminal 524 which couples to electrical pin526 in the controller connector 120, electrical pin 528 in the wandconnector 114, and ultimately to the return electrode(s). Additionalactive terminals and/or return terminals may be used. The activeterminal 518 is the terminal upon which the voltages and electricalcurrents are induced by the voltage generator 516, and the returnterminal 524 provides a return path for electrical currents. It would bepossible for the return terminal 524 to provide a common or ground beingthe same as the common or ground within the balance of the controller104 (e.g., the common 530 used on push-buttons 132), but in otherembodiments the voltage generator 516 may be electrically “floated” fromthe balance of the controller 104, and thus the return terminal 524,when measured with respect to the common or earth ground (e.g., common530) may show a voltage; however, an electrically floated voltagegenerator 516 and thus the potential for voltage readings on the returnterminals 524 relative to earth ground does not negate the returnterminal status of the terminal 524 relative to the active terminal 518.

The AC voltage signal generated and applied between the active terminal518 and return terminal 524 by the voltage generator 516 is RF energythat, in some embodiments, has a frequency of between about 5 kilo-Hertz(kHz) and 20 Mega-Hertz (MHz), in some cases being between about 30 kHzand 2.5 MHz, in other cases being between about 50 kHz and 500 kHz,often less than 350 kHz, and often between about 100 kHz and 200 kHz. Insome applications, a frequency of about 100 kHz is useful because targettissue impedance is greater at 100 kHz.

The RMS (root mean square) voltage generated by the voltage generator516 may be in the range from about 5 Volts (V) to 1800 V, in some casesin the range from about 10 V to 500 V, often between about 10 V to 400 Vdepending on the mode of ablation and active electrode size. Thepeak-to-peak voltage generated by the voltage generator 516 for ablationin some embodiments is a square waveform in the range of 10 V to 2000 V,in some cases in the range of 100 V to 1800 V, in other cases in therange of about 28 V to 1200 V, and often in the range of about 100 V to740 V peak-to-peak.

The voltage and current generated by the voltage generator 516 may bedelivered as a square wave voltage signal or sine wave voltage with asufficiently high frequency (e.g., on the order of 5 kHz to 20 MHz) suchthat the voltage is effectively applied continuously as compared with,e.g., lasers claiming small depths of necrosis, which are pulsed about10 Hz to 20 Hz). In addition, the duty cycle of a square wave voltageproduced by the voltage generator 516 is on the order of about 50% forsome embodiments (e.g., half the time as a positive voltage squaresignal, and half the time as a negative voltage square signal) ascompared with pulsed lasers which may have a duty cycle of about0.0001%. Although square waves are generated and provided in someembodiments, the AC voltage signal is modifiable to include suchfeatures as voltage spikes in the leading or trailing edges of eachhalf-cycle, or the AC voltage signal is modifiable to take particularshapes (e.g., sinusoidal, triangular).

The voltage generator 516 delivers average power levels ranging fromseveral milliwatts to hundreds of watts per electrode, depending on themode of operation and state of the plasma proximate to the activeelectrode(s). The voltage generator 516 in combination with theprocessor 500 are configured to set a constant root mean square (RMS)voltage output from the voltage generator 516 based on the mode ofoperation selected by the surgeon (e.g., one or more ablation modes,coagulation mode). A description of various voltage generators 516 canbe found in commonly assigned U.S. Pat. Nos. 6,142,992 and 6,235,020,the complete disclosure of both patents are incorporated herein byreference for all purposes. Reference is also made to commonly assignedU.S. Pat. No. 8,257,350, titled “METHOD AND SYSTEM OF AN ELECTROSURGICALCONTROLLER WITH WAVE-SHAPING”, the complete disclosure of which isincorporated herein by reference as if reproduced in full below.

In some embodiments, the voltage generator 516 may be controlled by aprogram executing on the processor 500 by way of digital-to-analogconverter 506. For example, the processor 500 may control the outputvoltages by providing one or more variable voltages to the voltagegenerator 516, where the voltages provided by the digital-to-analogconverter 506 are proportional to the voltages to be generated by thevoltage generator 516. In other embodiments, the processor 500 maycommunicate with the voltage generator by way of one or more digitaloutput signals from the digital output converter 508, or by way ofpacket-based communications using the communication device 512 (thecommunication-based embodiments not specifically shown so as not tounduly complicate FIG. 5 ).

Still referring to FIG. 5 , in some embodiment the controller 104further comprises a mechanism to sense the electrical current providedto the active electrode. In the illustrative case of FIG. 5 , sensingcurrent provided to the active electrode may be by way of a currentsense transformer 532. In particular, current sense transformer 532 mayhave a conductor of the active terminal 518 threaded through thetransformer such that the active terminal 518 becomes a single turnprimary. Current flow in the single turn primary induces correspondingvoltages and/or currents in the secondary. Thus, the illustrativecurrent sense transformer 532 is coupled to the analog-to-digitalconverter 514. In some cases, the current sense transformer may coupleto the analog-to-digital converter 514 through amplification circuits,protection circuits, and/or circuits to convert the sensed values toRMS. In particular, in the example system of FIG. 5 the current sensetransformer couples to an RMS circuit 534. RMS circuit 534 is anintegrated circuit device that takes the indication of current from thecurrent sense transformer 532, calculates a RMS value over any suitableperiod of time (in some example systems, over a 10 millisecond rollingwindow), and provides the RMS current values to the processor 500through the analog-to-digital converter 514 (shown by bubble A). Othercommunicative couplings between the RMS circuit 534 and the processor500 are contemplated (e.g., serial communication over an I²C or USBpathway, Ethernet communication). The current sense transformer 532 ismerely illustrative of any suitable mechanism to sense the currentsupplied to the active electrode, and other systems are possible. Forexample, a small resistor (e.g., 1 Ohm, 0.1 Ohm) may be placed in serieswith the active terminal 518, and the voltage drop induced across theresistor used as an indication of the electrical current. Given that thevoltage generator 516 is electrically floated, the mechanism to sensecurrent is not limited to the just the active terminal 518. Thus, in yetstill further embodiments, the mechanism to sense current may beimplemented with respect to the return terminal 524. For example,illustrative current sense transformer 532 may be implemented on aconductor associated with the return terminal 524.

Still referring to FIG. 5 , controller 104 in accordance with exampleembodiments further comprises the peristaltic pump 118. The peristalticpump 118 may reside at least partially within the enclosure 122. Theperistaltic pump comprises the rotor 124 mechanically coupled to a shaftof the electric motor 536. In some cases, and as illustrated, the rotorof the electric motor may couple directly to the rotor 124, but in othercases various gears, pulleys, and/or belts may reside between theelectric motor 536 and the rotor 124. The electric motor 536 may takeany suitable form, such as an AC motor, a DC motor, and/or astepper-motor. To control speed of the shaft of the electric motor 536,and thus to control speed of the rotor 124 (and the volume flow rate atthe wand), the electric motor 536 may be coupled to a motor speedcontrol circuit 538. In the illustrative case of an AC motor, the motorspeed control circuit 538 may control the voltage and frequency appliedto the electric motor 536. In the case of a DC motor, the motor speedcontrol circuit 538 may control the DC voltage applied to the electricmotor 536. In the case of a stepper-motor, the motor speed controlcircuit 538 may control the current flowing to the poles of the motor,but the stepper-motor may have a sufficient number of poles, or iscontrolled in such a way, that the rotor 124 moves smoothly. Statedotherwise, the rotor 124 moves smoothly due to the high number of stepsper turn. The processor 500 couples to the motor speed control circuit536, such as by way of the digital-to-analog converter 506 (as shown bybubble C).

While preferred embodiments of this disclosure have been shown anddescribed, modifications thereof can be made by one skilled in the artwithout departing from the scope or teaching herein. The embodimentsdescribed herein are exemplary only and are not limiting. Because manyvarying and different embodiments may be made within the scope of thepresent inventive concept, including equivalent structures, materials,or methods hereafter thought of, and because many modifications may bemade in the embodiments herein detailed in accordance with thedescriptive requirements of the law, it is to be understood that thedetails herein are to be interpreted as illustrative and not in alimiting sense.

What is claimed is: 1-18. (canceled)
 19. A method of treating a targettissue using an electrosurgical wand comprising: accessing andmanipulating the target tissue with a fine tip at a distal end of theelectrosurgical wand, the fine tip comprising; an apex portion of anactive electrode that has a planar outer surface, the planar outersurface extending along the longitudinal central axis, and laterallyoffset from the longitudinal central axis; and a tapered distal tip ofan electrically insulative support member, the tapered distal tipaxially coextensive with the apex portion and including a contoureddistal facing surface including a concave surface portion and a convexsurface portion that are both laterally offset from the longitudinalcentral axis; and applying a high frequency voltage between the activeelectrode and a return electrode spaced away from the active electrode,the high frequency voltage sufficient to generate a plasma proximate thetarget tissue.
 20. The method of claim 19 wherein accessing andmanipulating includes hooking the target tissue with the concave surfaceportion of the electrically insulative support member.
 21. The method ofclaim 19 wherein accessing and manipulating includes separating a labrumfrom a glenoid surface with the fine tip.
 22. The method of claim 19wherein accessing and manipulating includes dissecting between muscleplanes with the fine tip.
 23. The method of claim 19 further comprisingfinely dissecting or debriding cartilage or meniscus with the fine tipwhile applying the high frequency voltage.
 24. The method of claim 19wherein the electrically insulative support member also includes a shelfextending axially along the electrically insulative support member,spaced between the active electrode and the longitudinal central axisand orientated at an acute angle relative to the active electrode planarouter surface, and wherein the method further comprises using the selfas a visual marker for the location of the fine tip.
 25. A method oftreating a target tissue using an electrosurgical wand comprising:hooking a tissue associated with the target tissue, the hooking with adistally extending projection of the electrosurgical wand, the entiredistally extending projection extending axially along a single side of alongitudinal central axis of the electrosurgical wand, the distallyextending projection including; an apex portion of an active electrode;and a tapered distal tip of an electrically insulative support member,the tapered distal tip axially coextensive with the apex portion andincluding a contoured distal facing surface including a concave surfaceportion and a convex surface portion; and applying a high frequencyvoltage between the active electrode and a return electrode spacedproximally from the active electrode, to electrosurgically treat thetarget tissue.
 26. The method of claim 25 wherein hooking the tissueengages the concave surface portion of the electrically insulativesupport member with the tissue.
 27. The method of claim 25 furthercomprising accessing and manipulating tissues associated with the targettissue with the distally extending projection before electrosurgicallytreating the target tissue.
 28. The method of claim 25 furthercomprising separating a labrum from a glenoid surface with the distallyextending projection.
 29. The method of claim 25 further comprisingfinely dissecting or debriding cartilage or meniscus with the distallyextending projection while applying the high frequency voltage.
 30. Themethod of claim 25 wherein the electrically insulative support memberalso includes a shelf extending axially along the electricallyinsulative support member, spaced between the active electrode and thelongitudinal central axis and orientated at an acute angle relative tothe longitudinal central axis, and wherein the method further comprisesusing the self as a visual marker for the location of the distallyextending projection.
 31. A method of accessing and dissecting a targettissue using an electrosurgical wand comprising: accessing the targettissue, the accessing with a distal-most projection of theelectrosurgical wand, the entire distal-most projection extendingaxially along a single side of a longitudinal central axis of theelectrosurgical wand, the distal most projection including; an activeelectrode apex portion; and a tapered distal tip of an electricallyinsulative support member, the tapered distal tip axially coextensivewith the apex portion and including a contoured distal facing surfaceincluding a concave surface portion and a convex surface portion;dissecting around the target tissue with the distal-most projection; andapplying a high frequency voltage between the active electrode and areturn electrode spaced proximally from the active electrode apexportion, to electrosurgically dissect around the target tissue.
 32. Themethod of claim 31 wherein accessing and dissecting the target tissueengages the concave surface portion with the target tissue.
 33. Themethod of claim 31 wherein accessing and dissecting separates a labrumfrom a glenoid surface with the distal-most projection.
 34. The methodof claim 31 further comprising finely dissecting or debriding cartilageor meniscus with the distal-most projection while applying the highfrequency voltage.
 35. The method of claim 31 wherein the electricallyinsulative support member also includes a shelf extending axially alongthe electrically insulative support member, spaced between the activeelectrode and the longitudinal central axis and orientated at an acuteangle relative to the longitudinal central axis, and wherein the methodfurther comprises using the self as a visual marker for the location ofthe distal-most projection.